Management Of Post-term Pregnancy Research Articles

Outpatient balloon catheter versus expectant management for post-term labor induction in nulliparous women: A randomized trial

BackgroundIncreased use of labor induction has renewed interest in outpatient cervical ripening. Post-term pregnancy (i.e., ≥41 weeks) is a specific situation of increased neonatal risk, including greater risk of perinatal death and adverse perinatal outcomes. While a high proportion of these patients will need induction, outpatient management of this specific population has never been studied. Therefore, our objective was to compare two policies of management of post term pregnancies: the use of a transcervical Foley catheter for outpatient cervical ripening compared with expectant management. MethodsMulticenter, randomized controlled open-label study comparing home induction with a Foley catheter versus expectant management. Inclusion criteria were nulliparous, live singleton fetus in a vertex position, post-term (at 41 + 4 days), requiring cervical ripening (Bishop score <6), intact membranes, and distance home-hospital within 40 min. The primary endpoint was change in Bishop score beetween randomization (41 + 4 days) and consultation (41 + 5 days). ResultsForty-five women were included: 21 in the home induction group and 24 in the control group. The study was stopped due to low recruitment. The difference in Bishop score increases one day after randomization approached significance (p = 0.055), with home induction showing a larger change compared with expectant management (Cohen's d = 0.60; 95 % confidence interval [CI] −0.002 to 1.21). Regarding change in Bishop score, 81 % of home induction group patients had a better score at 41 + 5 days versus 52.2 % in the control group (relative risk = 1.55; 95 %CI 0.99 to 2.15). ConclusionBy specifically evaluating home induction in nulliparous women with post term pregnancies, we observed a Bishop score improvement in the home induction group. These data support further evaluation of induction methods and birth experiences in a larger cohort of this population. Trial registrationThe study was registered under European policy (number EudraCT 2015-A01298–41) and on www.clinitrials.gov (number NCT02932319). Date of registration: 13/10/2016, Date of initial participant enrollment: 31/03/2017

Management of Post-Term Pregnancy at The Provincial Reference Hospital of Jason Sendwe Lubumbashi “An observational study”

Objective: to study the physiopathological, clinical and therapeutic aspects of post-term pregnancies at the gynecology and obstetrics unit of the provincial general hospital of Jason Sendwe Materials and Method: it concerned a retrospective observational study with a comprehensive convenient sampling carried out within a period of 3 years going from January 2018 to December 2021. Inclusion criteria to the study concerned registered pregnant women with a gestational age greater than or equal to 42 weeks of amenorrhea with a complete exploitable partogram. Collected data were recorded and analyzed by Microsoft office 2016 and Epi Info 7.2.0.1. Results: during the study period, 61 cases of post-term pregnancies were registered on a total of 2100 childbirths. Yet, only 54 cases responded to our inclusion criteria of which the results follows. The mean age of our sample study was 27.04 years. The age range of [21-24] and [31-35] years mainly represented 25.93% both. 68.52% of the pregnant women were not followed-up for their pregnancies. Most post-terms were observed in the population of multigestes/multiparous (38.89%/29.63%) and primigestes/primiparous (33.33%/27.78%) respectively. Among the sample study, 48.15% underwent an artificial induction of labor. We recorded 12.96% of neonatal death among our population sample during study period. Conclusion: A relatively increased neonatal mortality of 12.96% was recorded in the post term gestations with 16.66% of the new born admitted to intensive care at birth, evidence that gestational advanced age is a risk factor for perinatal morbidity and mortality increases.

Being in limbo: Women\u2019s lived experiences of pregnancy at 41 weeks of gestation and beyond \u2013 A phenomenological study

BackgroundGlobally, the prevalence of post term pregnancy (PTP) is about 5-10%, but the rate varies considerably between and within countries. PTP is defined as a pregnancy ≥294 days, but the definition is arbitrary. Many studies focusing on the prevalence, risks and management of PTP include pregnancies ≥41 gestational weeks (GW). However, qualitative interview studies concerning women’s experiences of PTP are lacking. Therefore, the aim of this study was to describe women’s lived experiences of a pregnancy ≥41 GW.MethodThe study has a lifeworld research approach. Individual in-depth interviews were conducted from August 2013 to September 2014 with 10 healthy women with an expected normal pregnancy at GW 41 + 1-6 days in Gothenburg, Sweden. Interviews were conducted at the antenatal clinic or in the woman’s home, depending on her preference. Data were analysed with a phenomenological reflective lifeworld approach.ResultThe essence of women’s experiences of a pregnancy at GW ≥ 41 was described as being in limbo, a void characterised by contradictions related to time, giving birth and the condition. Exceeding the estimated date of childbirth implied a period of up to 2 weeks that was not expected. The contradictory aspect was the notion that time passed both slowly and quickly. Negative feelings dominated and increased over time. The women experienced difficulty due to not being in complete control, while at the same time finding it a beneficial experience. Health care professionals focused solely on the due date, while the women felt neither seen nor acknowledged. Lack of information led to searches in social media. Previously, they had trusted the body’s ability to give birth, but this trust diminished after GW 41 + 0. In this state of limbo, the women became more easily influenced by people around them, while in turn influencing others.ConclusionsBeing in limbo represents a contradictory state related to time and process of giving birth, when women need to be listened to by healthcare professionals. An understanding of the importance of different information sources, such as family and friends, is necessary. It is vital that women are seen and acknowledged by midwives at the antenatal clinics. In addition, they should be asked how they experience waiting for the birth in order to create a sense of trust and confidence in the process.

Introduction of Routine Obstetric Ultrasound in an Urban Health Center: Results and Benefits

Background Maternal mortality ratio (MMR) in India is 200/100,000 live births, many of which are preventable. To reduce MMR, the Government of India has set up basic obstetric ultrasonography facilities in primary health centers. This service was introduced in a nurse-run, low-risk antenatal and delivery service in an urban health center. This report documents the benefit of prenatal ultrasound in an urban health center. Methods This is a retrospective observational study carried out in an urban health center of a tertiary medical college and hospital, which provides health services to the economically disadvantaged urban population. The urban health center runs a nurse-led low-risk antenatal and delivery service. All consecutive antenatal ultrasounds from March 2012 to February 2013 were analyzed. Routine obstetric ultrasound was done for all women at their booking visit. Crown-rump length was measured if the first visit was prior to 13 weeks of gestation. If they presented after 13 weeks of gestation, biparietal diameter and femur length were measured to confirm gestational age. Results A total of 715 obstetric ultrasounds were performed during the period from 2012 to 2013. Among the 715 ultrasounds, 71.6% were for estimation of gestational age and 15.7% were for amniotic fluid index estimation for fetal surveillance. Among the dating ultrasounds performed, 48.6% were for primigravida women and 51.4% were for multigravida women. Discrepancies were identified in the expected date of confinement by the last menstrual period in 26% of the dating ultrasounds and 4.2% of women were identified to have a missed abortion at booking visit. Conclusion Maternal morbidity and mortality can be reduced by early detection of missed abortion, placenta previa, twin pregnancy, and molar pregnancy by routine obstetric ultrasound at booking visit. Routine obstetric ultrasound at the first and second trimesters had obvious benefits in confirming the expected date of delivery in a community where remembering the last menstrual period was not a priority. Introduction of this procedure helped in appropriate management of post-term pregnancies.

Effect of Oral Propranolol on Labor Induction

Effect of Oral Propranolol on Labor Induction

Significant effects on neonatal morbidity and mortality after regional change in management of post-term pregnancy

Significant effects on neonatal morbidity and mortality after regional change in management of post-term pregnancy

P32.12: Interobserver repeatability of ultrasound 3D volume cervix in post‐term pregnancies

Results: 101 and 67 patients were enrolled in group A and group B, respectively. For each patient a median of 2.9 evaluations (group A = 2.1, group B = 3.7; P = n.s.) was performed. The indications of hospital admission were: decreased volumes of amniotic fluid (AFI <50 mm) in 34 cases, abnormal cardiotocography in 19 cases, pregnancy after 41 weeks + 5 days in 11 cases, and spontaneous labor in the other 104 cases. The difference in caesarean section rate between the two groups such as neonatal outcome, birth weight, Apgar score, pH and neonatal intensive care unit admission was not stastically significant. Conclusions: Our experience suggest that the management of postterm pregnancies might be performed until 41+5 gestational weeks in outpatients’ department, according to patients’ characteristics, with a clinical and ultrasound evaluation of fetal conditions.

Contemporary management of post-term pregnancy: how long is too long?

The timely onset of labor and delivery is an important determinant of perinatal outcome. Post-term (prolonged) pregnancy refers to any pregnancy that continues beyond 42 weeks (294 days) of gestation. It complicates 10% of all deliveries and is associated with increased perinatal and neonatal morbidity and mortality, including stillbirth, birth injury, meconium aspiration syndrome, neonatal encephalopathy and infant mortality. Post-term pregnancy also poses significant risk to the mother, including an increased risk of cesarean delivery, severe perineal injury and postpartum hemorrhage. Fortunately, post-term pregnancy can be avoided by earlier induction of labor. The risks of continuing pregnancy beyond the due date, the option of induction of labor and the management of low-risk post-term pregnancies are reviewed.

Factors affecting outcome in post-term birth

Studies published in the past year confirm that, under current conditions of good ascertainment of gestational age and careful clinical management of post-term pregnancies, post-term births are not at increased risk of perinatal mortality. They are, however, still at increased risk of intrapartum fetal distress and cesarean birth. The main risk factor for poor fetal and neonatal outcomes is small fetal size. Risk markers for those at risk of intrapartum difficulties include amniotic fluid volume and fetal biophysical profile. While there is no longer increased mortality associated with post-term birth per se, this is very much the result of clinical selection factors and modern perinatal management. Post-term pregnancies remain an obstetrical risk group.

Survey on the Management of Post Date Pregnancy

A survey of the members of the Society of Perinatal Obstetricians was conducted to determine the current strategies employed in the management of post term pregnancies. In November 1990 a questionnaire was mailed to 1,000 members and associates of The SPO. Six hundred seventy-nine (68%) questionnaires were returned. The results reflect that a variety of management strategies are employed in management of post term pregnancy. With uncertain dates, 91% of the responders intervene only if antepartum testing is abnormal. With certain dates at 287 days and a favorable cervix, 63% of the responders will induce labor. With an unfavorable cervix, 83% begin antepartum testing. At certain 294 days and a favorable cervix, 98% induced labor. If the cervix is unfavorable, 58% induced labor, the majority of the remainder initiate antepartum testing. The consensus of SPO members responding to this questionnaire is that antepartum testing should begin at 287 days and labor should be induced at 294 days.

FETAL ASSESSMENT IN POSTTERM PREGNANCY

There is considerable disagreement over the management of postterm pregnancies. The main controversy is whether to adopt a policy of routine induction or one of selective induction allied to frequent fetal surveillance. Current evidence suggests that routine induction at 42 weeks' gestation does not increase the risk of instrumental delivery or cesarean section. To adopt the former approach, it is important that gestation is confirmed by early ultrasound examination, which has reduced the true incidence of postterm pregnancy to less than 6%. There have been no recent significant advances regarding methods of fetal surveillance in the postterm pregnancy.

Objective method of diagnosing oligohydramnios in postterm pregnancies.

Oligohydramnios is an important factor influencing the management of postterm pregnancies. However, sonographic assessment of oligohydramnios has been based largely on the subjective judgement of the sonologist. From January 1982 to December 1984, 54 patients had articulated-arm B-scan ultrasound examinations and were identified as postterm. Of these patients, 25 were subjectively diagnosed as having oligohydramnios. Five patients were considered to have low normal amounts of amniotic fluid. The remainder were considered to have normal or greater than normal quantities of amniotic fluid. From this population, an amniotic fluid index was determined for each patient by finding the product of the length, width, and depth of the largest amniotic fluid pocket. Patients with a fluid index less than 60 showed a strong association with the postmaturity syndrome. Indeed, all but one postmature infant was born of a pregnancy with a fluid index less than 60. No other fetal or perinatal complications were statistically correlated with oligohydramnios in this small patient series.